Months Later, Drug Shortages Still a Problem

The shock waves from Hurricane Maria, which barreled into Puerto Rico in September 2017, are still shaking the pharmaceutical supply chain. Puerto Rico is the home to more than 90 pharmaceutical manufacturing sites, and Maria caused shortages of drugs and medical products in the United States, notably intravenous bags of saline.

The storm left most factories with no power, and many had to operate on generators for long periods, says Nicolette Louissaint, PhD, executive director of Healthcare Ready, an organization that helps strengthen healthcare supply lines. The island’s airports also took a serious hit, which further hampered recovery operations, and at one point, a shortage of medical gases used in drug production caused more complications, she notes.

“Where we are now is a position where a lot of the facilities are back on commercial power and are able to resume normal operations, but there is a bit of a backlog,” Louissaint says. “One of the things we know in the preparedness and response world is that we all take for granted systems when they are not disrupted.”

The storm exposed serious vulnerabilities in the healthcare supply chains, says Joseph Hill, director of government relations for ASHP. “While I think things have gotten marginally better, I think that this was an extremely bad event,” he says. Although there have been drug and product shortages in the past, “this one was kind of a level beyond,” he points out.

Although FDA Commissioner Scott Gottlieb, MD, stated that there were 30 “critical” products made on Puerto Rico, 14 of which were made only there, but the FDA would not release a list of those products. The agency says that the list is proprietary.

“I get the arguments against [releasing a list] because you don’t want to cause hoarding or cause people to buy more than they should,” says Hill. “But my sense is that the industry can help out in terms of placing products on allocation.”

Hoarding could be a concern with releasing a list of affected products, agrees Erin Fox, PharmD, BCPS, senior director for Drug Information and Support Services at University of Utah Health. “But these companies are big boys and girls and they know how to allocate.”

One product still in short supply is IV bags and parenteral solutions from Baxter Healthcare, including amino acids, according to ASHP’s website. Both Fox and Hill note that IV bags of saline were in short supply before Maria hit.

Baxter says that its facilities in Puerto Rico are now connected to the electrical grid and are operating at their pre-hurricane levels. “Baxter has maintained backup diesel generators in all of our Puerto Rico facilities in case of power interruptions, which still occur intermittently,” the company states on its website.

A big question is whether the pharmaceutical industry will have set everything in order in Puerto Rico before the start of the next hurricane season. “It will depend on how soon the companies get up to speed,” says Fox.

ASHP has been engaging stakeholders in having discussions about how to deal with serious blows to the supply chain, says Hill. “We really need to have those discussion, because it's kind of a ticking time bomb,” says Hill. “If another big one hits and the island isn't already back to where it was pre-Hurricane Maria, you could have an even worse situation.”